Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan

Muhammad Ishrat Husain; Imran B Chaudhry; Raza R Rahman; Munir M Hamirani; Nasir Mehmood; Peter M Haddad; John Hodsoll; Allan H Young; Farooq Naeem; Nusrat Husain

doi:10.1186/s40345-017-0074-8

Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan

Muhammad Ishrat Husain, Imran B Chaudhry, Raza R Rahman, Munir M Hamirani, Nasir Mehmood, Peter M Haddad, John Hodsoll, Allan H Young, Farooq Naeem, Nusrat Husain

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Abstract

BACKGROUND: Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan.

AIM: The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan.

METHODS: Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients.

RESULTS: Retention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88).

CONCLUSIONS: Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings.

TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02210390.

Original language	English
Pages (from-to)	3
Journal	International Journal of Bipolar Disorders
Volume	5
Issue number	1
Early online date	1 Feb 2017
DOIs	https://doi.org/10.1186/s40345-017-0074-8
Publication status	E-pub ahead of print - 1 Feb 2017

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Husain, M. I., Chaudhry, I. B., Rahman, R. R., Hamirani, M. M., Mehmood, N., Haddad, P. M., Hodsoll, J., Young, A. H., Naeem, F., & Husain, N. (2017). Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan. International Journal of Bipolar Disorders, 5(1), 3. Advance online publication. https://doi.org/10.1186/s40345-017-0074-8

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abstract = "BACKGROUND: Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan.AIM: The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan.METHODS: Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients.RESULTS: Retention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88).CONCLUSIONS: Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings.TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02210390.",

author = "Husain, {Muhammad Ishrat} and Chaudhry, {Imran B} and Rahman, {Raza R} and Hamirani, {Munir M} and Nasir Mehmood and Haddad, {Peter M} and John Hodsoll and Young, {Allan H} and Farooq Naeem and Nusrat Husain",

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doi = "10.1186/s40345-017-0074-8",

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T1 - Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan

AU - Husain, Muhammad Ishrat

AU - Chaudhry, Imran B

AU - Rahman, Raza R

AU - Hamirani, Munir M

AU - Mehmood, Nasir

AU - Haddad, Peter M

AU - Hodsoll, John

AU - Young, Allan H

AU - Naeem, Farooq

AU - Husain, Nusrat

PY - 2017/2/1

Y1 - 2017/2/1

N2 - BACKGROUND: Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan.AIM: The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan.METHODS: Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients.RESULTS: Retention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88).CONCLUSIONS: Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings.TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02210390.

AB - BACKGROUND: Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan.AIM: The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan.METHODS: Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients.RESULTS: Retention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88).CONCLUSIONS: Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings.TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02210390.

U2 - 10.1186/s40345-017-0074-8

DO - 10.1186/s40345-017-0074-8

M3 - Article

C2 - 28155203

SN - 2194-7511

VL - 5

SP - 3

JO - International Journal of Bipolar Disorders

JF - International Journal of Bipolar Disorders

IS - 1

ER -

Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan

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